Decreasing Polypharmacy in Older Adults With Curable Cancers Trial

This is a single-site cluster-randomized trial to assess efficacy and implementation outcomes of deprescribing interventions in 72 older adults with polypharmacy (PP) and curable cancers initiating chemotherapy. Oncologists (as the cluster) will enroll 6 patients each and will be randomized to either a pharmacist-led deprescribing intervention or patient education intervention. Initial focus groups with oncologists, nurses, pharmacists, primary care physicians, and patients will provide data for initial adaptations to the pharmacist-led intervention arm, and 8 patients will be enrolled as a pre-trial cohort to further refine and adapt the pharmacist-led intervention.

Inclusion Criteria: * Be age ≥65 years; * Have a diagnosis of malignancy including aggressive lymphoma or cancers of the breast, gastrointestinal system, genitourinary system, or lung; * Be initiating chemotherapy, alone or in combination with other systemic antineoplastic agents, (for a period of at least 3 months) within 4 weeks of enrollment; * Screen positive for polypharmacy (\>10 medications) or potentially inappropriate medications * Be able to read and write English; * Be able to give informed consent, as determined by the primary oncologist, or has a legally authorized representative to sign consent in the case of cognitive impairment. Exclusion Criteria: * Be planned to receive a cancer treatment regimen that does not include standard cytotoxic chemotherapy (e.g., only targeted therapies, hormonal therapies, monoclonal antibody therapies, immunotherapy, etc.), * Have surgery or radiation without concurrent chemotherapy planned within 3 months of consent, * Have a planned referral to the geriatric oncology clinic (SOCARE) within one month of treatment initiation, * Lack decisional capacity, if a legally authorized representative is not available to sign consent and participate in study visits and follow-up phone calls.